HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
I LW-014-1 RECEIVED
Building Permit ApplicationmAy 6 $ 2019
Planning and Development Services
Building and Code Regulation Division ST. Lucie Cownty, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: 4[C—
PROPOSED IMPROVEMENT LOCATION: A
Address:
Property Tax lD#: Lot Na.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
C3 Sl_,e u % Y\PAA-1
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CONSTRUCTION INFORMATION:
Addi=tionorktobe performed under this permit-check all that apply:
echanical —Gas Tank Gas Piping Shutters Windows/Doors
Electric —Plumbing Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: GCD Sq. Ft.of First Floor:
Cost of Construction: Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name r- Name._V1\JNM
Address Company:Company:t4k'A.ts
e1:!� cz(xi4116_
City:T�' Stateft, Adclre6ss:WQJ:� S-vJ �
Zi Code: Fax: L City. State:F_L_
Phone No. -1� Zip Code:%14N5z Fax:
E-Mail: Phone No 5111
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License 0"Iq5"z'LC>
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
,L__
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT:'
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLO I A
COUNTY OF 63r. COUNTY OF V,
The forgoing instrument was acknowledged before me Theforgoing instrument was acknowledged before me
this 4b day of WNG� ,20� by this fb day of VvN 20_a by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L— Produced
+n
(Signature of Notar ublic-Stateo Si natur " tity P����hh��1I r a
DEANf1A�A N#GG ''L�23 ' _N EXPIRES:December 16,2(0
Commission No. ��' �yc(61 �I°m> r1c?o'.� ; Commissi FS oj�yPumicunre�:S1e'21)
EXPIRES:De81lGUndeR�r'! "-; ....,,
1,"�• sidedYhNfdolaN , ,
REVIEWS FRONP��I`Rgar SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19